As part of President Biden’s investment and commitment to home care, New York State is slated to receive in excess of 1.4 billion dollars from the federal government over the course of the next two fiscal years. The funds will be distributed to qualifying providers in two phases. It is anticipated that the first payment, 361 million, will be made sometime between January 1, 2022 and March 31, 2022. The second – and larger – payments are slated for distribution sometime between April 1, 2022 and March 31, 2023.

The New York State Department of Health (“DOH”) has developed the eligibility criteria for these funds. The DOH’s plan, however, is subject to CMS approval.  The DOH has submitted its plan to CMS for approval, and CMS is expected to respond by January 3, 2022.

As proposed by the DOH, the top billing 1/3 of LHCSAs (approximately 250 agencies) have been selected for the first wave of funding, based on those agencies’ MLTC revenue from 2019.  FIs and CHHAs are not eligible for these funds. The State would determine the specific provider award amounts. MLTCs and MAPs would receive the “payment amounts per provider from the State” sometime before March 31, 2022. The plans would then have to pass this money, dollar for dollar, to the providers. There is no ability for plans to retain any portion of these funds.

The funds must be used by the awarded providers in State’s FY 22 and FY 23 to “strengthen their workforces and prepare for VBP arrangements with reporting to DOH.”

Insofar as the selection of providers, the DOH explained that only LHCSAs with managed care revenue that “meets or exceeds the revenue threshold in their respective regions” would be included in the class of recipients. The threshold was set by the DOH as the “66th percentile of providers in each region based on provider revenue, meaning that the 1/3 of providers with the highest managed care revenue in each region would be included in the provider class.” The DOH has stated that the approximately 250 LHCSAs that had been selected for these funds account for 93% of the total Medicaid personal care spending in New York. The DOH also stated that each region was uniquely considered.

In describing the plan, and why the State chose to limit the awards to only 1/3 of the providers, the DOH stated that it “intended to send a message to providers.” It is not clear what that message is, but it seems that the distribution of funds to top-billing providers aligns with the State’s longstanding mission to consolidate and reduce the number of LHCSAs in New York State.

The list of the approximately 250 providers has not been published or shared by the DOH.

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